Subacute Thyroiditis de Quervain

Subacute Thyroiditis de Quervain

De Quervain’s subacute thyroiditis is a disease of the thyroid gland. Among other things, those affected suffer from pain in the thyroid gland.

What is subacute de Quervain thyroiditis?

A rare disease of the thyroid gland is subacute thyroiditis de Quervain. The disease was named after the Swiss physician Johann Friedrich de Quervain (1868-1940). De Quervain worked for a long time at the University of Bern and described subacute thyroiditis in 1904. For testicular torsion in English, please visit gradphysics.com.

The condition is also known as Quervain thyroiditis, subacute nonsuppurative thyroiditis, viral thyroiditis, or giant cell thyroiditis. De Quervain’s subacute thyroiditis is a general disease that occurs relatively suddenly (subacutely). The main symptom is the painful inflammation of the thyroid gland.

The subacute thyroiditis de Quervain is one of the rare diseases. About 5 out of 100,000 people suffer from it every year. Thyroid disease is most common between the ages of 30 and 50. Women are more frequently affected by subacute thyroiditis than men. Outbreaks of the disease are more frequent in spring and autumn in particular.

Causes

To this day, medicine has not been able to find out what causes de Quervain’s subacute thyroiditis. However, it is suspected that it arises from a viral infection. Most patients suffered from an upper respiratory tract infection before they became ill. However, no connection with typical viral infections such as those caused by Coxsackie viruses or enteroviruses could be established.

Genetic predispositions are also part of the medical discussion. Thus, subacute de Quervain thyroiditis seems to break out frequently in people who carry the leukocyte antigens HLA-B35 and HLA-B67. With HLA-B35 there is even a 50-fold risk of developing the disease. Familial accumulations could only be proven in isolated cases.

Thyroid disease is thought to result from both a viral infection and an autoimmune response by the body against the tissues of the thyroid gland. On the other hand, however, there is a self-limitation of subacute thyroiditis de Quervain, which is not usually common in autoimmune diseases.

Symptoms, Ailments & Signs

A typical feature of subacute de Quervain thyroiditis is its subacute onset. In addition, the disease progresses in several phases, whereby the symptoms are not the same for every patient. Unilateral pain in the thyroid gland is often classified as the main symptom of subacute thyroiditis.

These can radiate into the ear or into the jaw. Swelling develops on the inflamed thyroid lobe. In addition, it is sensitive to pressure. Furthermore, there are various general complaints.

These include tiredness, exhaustion, muscle pain, body aches, a sore throat, difficulty swallowing or a slight fever. The inflammation results in destruction of the thyroid follicles. The thyroid protein thyroglobulin, which is located in the follicles, is broken down.

There is also an uncontrolled release of the thyroid hormones thyroxine and triiodothyronine into the blood. The increased concentration of thyroid hormones in turn causes the inhibition of thyrotropin in the pituitary gland (pituitary gland), which counteracts the formation of new thyroid hormones.

In about half of all patients, the hormone excess leads to symptoms of poisoning (thyrotoxicosis). In the case of an overactive thyroid gland, those affected suffer from increased heartbeat, excessive sweating, tremors, nervousness and weight loss.

If the stores of thyroid hormones are exhausted, the result is hypothyroidism. It manifests itself in reduced performance, weight gain, lack of drive, low blood pressure and a slow heartbeat.

Diagnosis & course of disease

If the disease leads the patient to see a doctor, the doctor can describe the symptoms in detail. The typical symptoms usually point to subacute thyroiditis. To secure the diagnosis, the doctor carries out a blood test, which reveals elevated CRP values ​​(C-reactive protein) and increased blood sedimentation rate (ESR).

Furthermore, a sonography (ultrasound examination) is carried out, in which mostly hypoechoic foci are identified in the thyroid gland. It is not uncommon for these to expand into larger herds. In case of doubt, a scintigraphy of the thyroid gland can also be carried out.

Fine-needle aspiration is also possible for tissue removal, which is then examined histologically. However, these tests are only used in individual cases. The exact course of subacute de Quervain thyroiditis is difficult to predict.

The duration of the illness can vary between a few months and more than a year. Because the inflammation of the thyroid eventually comes to a standstill on its own, even without treatment, the disease usually has a positive outcome.

Complications

Subacute de Quervain thyroiditis can lead to a number of complications. Most patients experience muscle and joint pain, difficulty swallowing and inflammation as the disease progresses. The typical fever can continue to rise if there is a lack of treatment or a poor constitution of the person affected and lead to overloading of the cardiovascular system.

Difficulty swallowing is often associated with aspiration, which in the worst case can lead to pneumonia. The inflammation itself results in the destruction of the thyroid follicles. The hormone excess leads to symptoms of intoxication in half of all patients. This is accompanied by sweating, nervousness and weight loss.

If the thyroid hormones are depleted, an underactive thyroid occurs. This is associated with reduced performance, weight gain and cardiovascular problems. Heart rate usually slows down and blood pressure decreases. Circulatory disorders, impaired consciousness and other complications can be the result.

The rapid change from hyperfunction to hypofunction also increases the risk of serious circulatory problems. Apart from the side effects caused by ibuprofen, diclofenac and other medications, the treatment is relatively symptom-free. However, occasionally serious interactions can occur. Allergic reactions cannot be ruled out either.

When should you go to the doctor?

With this disease, a visit to a doctor is usually always necessary and also unavoidable. If the person affected with thyroiditis de Quervain does not consult a doctor, severe complications and other symptoms usually occur, which in the worst case can even lead to the death of the person concerned. The sooner a doctor is consulted, the better the further course.

A doctor should be consulted if the person concerned suffers from very severe pain in the jaw or ears, which does not go away on its own. Nor can they be treated through self-help measures. In many cases, swelling in the affected regions can also indicate the disease. It is not uncommon for patients to suffer from exhaustion or severe pain in the muscles, which occurs for no particular reason. Sweating or severe nervousness can also indicate the disease.

De Quervain’s thyroiditis can be diagnosed by a general practitioner. Further treatment is carried out by a specialist. Complete healing is not always possible.

Treatment & Therapy

In about 80 to 95 percent of all patients, subacute thyroiditis de Quervain heals by itself within a period of nine to twelve months. The symptoms are therefore combated as part of the therapy. For this purpose, the patient is given pain-relieving and anti-inflammatory drugs such as ibuprofen, diclofenac or acetylsalicylic acid.

If these drugs are not sufficient, glucocorticoids such as prednisolone can also be used to reduce inflammation. There are no treatment options available to treat hyperthyroidism in subacute de Quervain thyroiditis.

For example, treatment with antithyroid drugs is of no use because there is only an increased release of thyroid hormones that are already present. About five percent of all patients suffer from permanent hypothyroidism, so that they have to receive thyroid hormones for the rest of their lives.

Prevention

Preventive measures against subacute thyroiditis de Quervain are not known. So far, the causes of the thyroid disease could not be determined.

Aftercare

Complete recovery is possible in subacute de Quervain thyroiditis. This lasts from a few months to a year. The muscle and joint pain as well as inflammation can be treated with medication. Painkillers such as ibuprofen, acetylsalicylic acid or diclofenac are used. Neck wraps with cool water can help.

In the case of existing swallowing difficulties, treatment with medication is also advisable in order to avoid further diseases of the respiratory tract such as pneumonia. In some cases, the inflammation of the thyroid stops on its own. A doctor should regularly check the thyroid levels in order to detect under- or over-functioning in good time.

In the case of hypofunction, lifelong intake of thyroid hormones may be necessary. This prevents side effects such as reduced performance, cardiovascular problems and weight gain. There is no drug treatment option for hyperfunction. Autogenic training such as yoga or meditation and herbal sedatives such as valerian or lemon balm can help with side effects such as nervousness and restlessness.

During the illness, the body should be spared. Sporting activities are not recommended and bed rest is also necessary if you have a fever. Adequate fluid intake and a healthy diet should be ensured. Subacute de Quervain thyroiditis usually has a positive course and does not have a lasting effect on quality of life and life expectancy. An early visit to the doctor improves the chances of recovery and reduces the risk of possible complications.

You can do that yourself

During a subacute thyroid inflammation, the body needs rest. Therefore, sport should only be practiced in consultation with a doctor. Sauna sessions are rather not recommended. If you have a fever, bed rest is required and the patient should drink enough. Cooling neck wraps relieve any pain. To do this, a linen cloth is folded lengthwise several times, dipped in cool water, squeezed out, placed around the neck and covered with a neckerchief or towel. Put on in the evening, the wrap can remain in place overnight. Some sufferers use ointment containing comfrey on their throats. However, the effectiveness of this measure has not been proven.

If there is a temporary overactive thyroid, relaxation exercises such as autogenic training help against restlessness and sleep disorders. Herbal sedatives based on valerian or lemon balm also relieve nervousness. Anyone who has to take cortisone can mitigate its side effects with the right diet : a protein-rich diet slows down the drug-related muscle breakdown. Whole grain products stabilize blood sugar and keep you full for a long time. Sugar, on the other hand, should be avoided. It increases the blood sugar level and strengthens the already increased appetite caused by the cortisone. Avoiding high-salt foods helps prevent water retention.

Even after subacute de Quervain thyroiditis has healed, patients should have their thyroid function checked once a year, because up to 15 percent develop persistent hypothyroidism that requires treatment.

Subacute Thyroiditis de Quervain